The role of medical evidence certifying PTSD for legal outcomes in Swedish asylum cases 2016-2020.

Medical evidence is introduced when health conditions are invoked as legally relevant circumstances in asylum cases. Although research shows that medical evidence can affect asylum outcomes, we lack systematic knowledge of how it is assigned legal relevance, especially for mental health conditions. The study draws on 175,394 asylum decisions issued by the Swedish Migration Agency in 2016, 2018, and 2020, selecting cases (N = 1021) referring to medical certificates concerning post-traumatic stress disorder (PTSD). Using a coding scheme, three researchers coded decision texts. The codes were used in logistic regression analyses and χ2 tests to examine whether and how the PTSD diagnosis and medical certificates (including formalities) affected credibility assessments and the likelihood of being granted a residence permit (28.5% positive). Our results indicate that medical evidence had no uniform legal effect unless assigned a function within the decision-making process. When the PTSD diagnosis was used in credibility assessments (18%), it influenced outcomes (χ2 = 134.48; p < 0.001), with OR = 30 for a positive decision when explaining credibility problems and OR = 0.36 when failing to do so. In contrast, the PTSD diagnosis was referred to in 85.9% of cases when assessing eligibility for a residence permit, with significantly lower odds (OR = 0.02) upon explicit mention. The formalities of the certificate showed no effect. These findings demonstrate context-dependent functions of the PTSD diagnosis in asylum decision-making, with divergent effects in credibility assessments and residence permit determinations, showing that clinical relevance does not necessarily translate into legal relevance.